Electrolytes balance

The osmolality of urine can differ markedly from that of plasma because of active concentrative processes in the renal tubules. The membranes of renal collecting ducts show varying degrees of water permeability and permit removal of certain solutes without simultaneous uptake of water. 

Plasma osmolality can be calculated from the concentrations of plasma Na+, glucose, and serum urea nitrogen  

ADH acts at the renal tubules and collecting ducts to raise cAMP levels. Urinary levels of cAMP are increased by ADH. Factors other than plasma hypertonicity may stimulate ADH secretion. Thus, in acute hemorrhage 

Inappropriate ADH secretion can occur in the presence of water overload and a decline in plasma Na+ concentration and osmolality. Fear, pain, and certain hormone-secreting tumors can cause inappropriate ADH secretion. It leads to hyponatremia and water retention. Morphine and barbiturates increase, and ethanol decreases, secretion of ADH. 

The major electrolytes are Na , K , Cl , and HCOJ (HCO3 is discussed below, under Acid-Base Balance. ) 

---

Corticosteroids exhibit a wide range of physiological effects One important func tion IS to assist m maintaining the proper electrolyte balance m body fluids They also play a vital regulatory role m the metabolism of carbohydrates and m mediating the alter gic response... 

As we have seen in this chapter steroids have a number of functions in human physiology Cholesterol is a component part of cell mem branes and is found in large amounts in the brain Derivatives of cholic acid assist the digestion of fats in the small intestine Cortisone and its derivatives are involved in maintaining the electrolyte balance in body fluids The sex hormones responsible for mascu line and feminine characteristics as well as numerous aspects of pregnancy from conception to birth are steroids... 

Magaldrate is an antacid having somewhat more efficacy than aluminum hydroxide. It does not appear to disturb electrolyte balance or bowel function. 

The adrenal cortex produces steroidal hormones that are associated with carbohydrate, fat, and protein metabolism, electrolyte balance, and gonadal functions (58). One of these, cortisone [53-06-5] ( ) demonstrated a remarkable ability to relieve the symptoms of inflammatory conditions... 

The integrity of mammalian kidneys is vital to body homeostasis, because the kidneys play the principal role in the excretion of metabolic wastes and the regulation of extracellular fluid volume, electrolyte balance, and acid-base... 

It was known as early as 1927 that the adrenal glands of mammalian species secrete a series of substances essential to the survival of the individual. The hormonal nature of these secretions was suggested by the observation that extracts of the adrenal gland and more specifically of the outer portion of that organ (cortex) would ensure survival of animals whose adrenals had been excised. By 1943 no fewer than 28 steroids had been isolated from adrenal cortical extracts. These compounds were found to be involved in the regulation of such diverse and basic processes as electrolyte balance, carbohydrate metabolism, and resistance to trauma, to name only a few. 

Intravenous replacement solutions are a source of electrolytes and water for hydration (Normosol M Ringer s Injection, Lactated Ringer s, Plasma-Lyte R), and used to facilitate amino acid utilization and maintain electrolyte balance (Lypholyte, Multilyte, TPN Electrolytes). Dextrose and electrolyte solutions such as Plasma-Lyte R and 5% dextrose are used as a parenteral source of electrolytes, calories, or water for hydration. Invert sugar-electrolyte solutions, such as Multiple Electrolytes and Travert 5% and 10%, contain equal parts of dextrose and fructose and are used as a source of calories and hydration. 

Saltin, B. Costill, D.L. (1988). Fluid and electrolyte balance during prolonged exercise. In Exercise, Nutrition, and Energy Metabolism (Horton, E.S. Teijung, R.L., ed), pp. 150-158, MacMillan. New York. 

The Newborn and the Laboratory. The wellbeing of the pre-mature infant can be ascertained by measuring blood pH, electrolytes and other blood components on a routine basis. The maintenance of these infants electrolyte balance and normal pH is shown in Figure 3. An infant placed on a high protein diet milk formula developed an acidosis, and when brought to normal pH... 

From the above, derives the fundamental concept that the newborn infant must be maintained in an adequate degree of hydration and in electrolyte balance in order for the infant to thrive. In some cases, where for one reason or other, the infant is not able to take fluids by mouth in the normal manner, one may need to resort to supplementary fluid therapy by vein. For a rational approach to this problem one needs to have available from the clinical chemical laboratory> rapid response in order to continuously monitor changes in electrolyte levels so that fluids can be modified so as to correct these abnormal-ities. 

Review available laboratory tests to examine electrolyte balance and renal function. 

Provide a plan to assess the effectiveness and safety of therapy. Follow-up in 2 to 4 weeks if the medication regimen has changed, otherwise semi-annual or annual clinic visits to assess blood pressure, electrolyte balance, and renal function should occur. 

Because disturbances in fluid balance are routinely encountered in clinical medicine, it is essential to have a thorough understanding of body fluid compartments and the therapeutic use of fluids. Similarly, disturbances in serum sodium, potassium, calcium, phosphorus, and magnesium are ubiquitous and must be mastered by all clinicians. Dysregulation of fluid and/or electrolyte status has serious implications regarding the concepts of drug absorption, volumes of distribution, and toxicity. Similarly, many medications can disrupt fluid and/or electrolyte balance as an unintended consequence. 

The posterior pituitary is innervated by direct nervous stimulation from the hypothalamus, resulting in the release of specific hormones. The hypothalamus synthesizes two hormones, oxytocin and vasopressin. These hormones are stored in and released from the posterior pituitary lobe. Oxytocin exerts two actions (1) it promotes uterine contractions during labor, and (2) it contracts the smooth muscles in the breast to stimulate the release of milk from the mammary gland during lactation. Vasopressin is an antidiuretic hormone (ADH) essential for proper fluid and electrolyte balance in the body. Specifically, vasopressin increases the permeability of the distal convoluted tubules and collecting ducts of the nephrons to water. This causes the kidney to excrete less water in the urine. Consequently, the urine becomes more concentrated as water is conserved. 

Hydration and electrolyte balance, often with ORT, are the cornerstone of treatment. The specific circumstances that antibiotics should be considered include high fevers, bloody stools, symptoms longer than 1 week, pregnancy, infection with HIV, and other immunocompromised hosts. 

Renin-angiotensin-aldosterone system (RAAS) The hormonal system controlled mainly by the kidneys and adrenal glands that regulates blood pressure, blood volume, and electrolyte balance. 

Commonly administered LVPs include such products as Lactated Ringers Injection USP, Sodium Chloride Injection USP (0.9%), which replenish fluids and electrolytes, and Dextrose Injection USP (5%), which provides fluid plus nutrition (calories), or various combinations of dextrose and saline. In addition, numerous other nutrient and ionic solutions are available for clinical use, the most popular of which are solutions of essential amino acids or lipid emulsions. These solutions are modified to be hypertonic, isotonic, or hypotonic to aid in maintaining both fluid, nutritional, and electrolyte balance in a particular patient according to need. Indwelling needles or catheters are required in LVP administration. Care must be taken to avoid local or systemic infections or thrombophlebitis owing to faulty injection or administration technique. 

Physiology is the study of the functions of the human body. In other words, the mechanisms by which the various organs and tissues carry out their specific activities are considered. Emphasis is often placed on the processes that control and regulate these functions. In order for the body to function optimally, conditions within the body, referred to as the internal environment, must be very carefully regulated. Therefore, many important variables, such as body temperature, blood pressure, blood glucose, oxygen and carbon dioxide content of the blood, as well as electrolyte balance, are actively maintained within narrow physiological limits. 

The kidneys are organs specialized to filter the blood. As such, they make an important contribution to the removal of metabolic waste products as well as to maintenance of fluid and electrolyte balance. Specific functions of the kidneys include ... 

Na/K Osmotic/electrolytic balance 4xl09 years increasing... 

---